1467093328 NPI number — MISS TESSA RACHEL CURTIS APRN, AGACNP

Table of content: MISS TESSA RACHEL CURTIS APRN, AGACNP (NPI 1467093328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467093328 NPI number — MISS TESSA RACHEL CURTIS APRN, AGACNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CURTIS
Provider First Name:
TESSA
Provider Middle Name:
RACHEL
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
APRN, AGACNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CURTIS
Provider Other First Name:
TESSA
Provider Other Middle Name:
RACHEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN, AGACNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1467093328
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6405 S 3000 E STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84121-6990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
836 S ANGEL ST STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAYTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84041-3687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-291-1375
Provider Business Practice Location Address Fax Number:
801-823-6595
Provider Enumeration Date:
10/02/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  9018056-3102 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LG0600X , with the licence number: 9018056-4405 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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